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General NPI Number Information
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NPI Number | 1225335417
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Entity Type | Organization
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Legal Business Name | IMPAR CORPORATION
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Dates
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Enumeration Date | 02/24/2011
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Last Update Date | 02/24/2011
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Provider Practice Location Address
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Address Line | 178 WESTERLY RD
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City | PLYMOUTH
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State | MA
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Zip | 02360-4535
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Country | US
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Telephone | 914-715-2171
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Fax | 774-283-9874
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Provider Business Mailing Address
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Address Line | 178 WESTERLY RD
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City | PLYMOUTH
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State | MA
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Zip | 02360-4535
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Country | US
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Telephone | 914-715-2171
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Fax | 774-283-9874
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Authorized Official
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Title or Position | PRESIDENT
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Name | IAN RIVERA
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Credential | MD
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Telephone | 914-715-2171
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208VP0014X
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Taxonomy Name | Interventional Pain Medicine Physician
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License Number | 234628
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License Number State | MA
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